Gender differences in ADHD: Implications for psychosocial treatments

Expert Review of Neurotherapeutics

Volumn 8, Issue 4, 2008, Pages 643-655

  Rucklidge, Julia J ^a  

^a UNIVERSITY OF CANTERBURY   (New Zealand)

Author keywords

ADHD; Females; Gender; Males; Psychosocial; Review; Sex difference; Treatment

Indexed keywords

AMPHETAMINE; CENTRAL STIMULANT AGENT; METHYLPHENIDATE;

ANXIETY DISORDER; ATTENTION DEFICIT DISORDER; COGNITION; COGNITIVE THERAPY; COMORBIDITY; DEPRESSION; DIFFERENTIAL DIAGNOSIS; FEMALE; HUMAN; MALE; PSYCHOSOCIAL CARE; REVIEW; SEX DIFFERENCE; SOCIAL PSYCHOLOGY;

ADOLESCENT; ATTENTION DEFICIT DISORDER WITH HYPERACTIVITY; CHILD; HUMANS; SEX FACTORS; SOCIAL SUPPORT;

EID: 42249112994     PISSN: 14737175     EISSN: 17448360     Source Type: Journal    
DOI: 10.1586/14737175.8.4.643     Document Type: Review

References (99)

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Association, DC, USA (2000).
2. Polanczyk G, de Lima McS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am. J. Psychiatry 164(6), 942-948 (2007).
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (3rd Edition). American Psychiatric Association, DC, USA (1980).
4. Gittelman R, Mannuzza S, Shenker R, Bonagura N. Hyperactive boys almost grown up. I. Psychiatric status. Arch. Gen. Psychiatry 42(10), 937-947 (1985).
5. Almeida Montes LG, Hernández García AO, Ricardo-Garcell J. ADHD prevalence in adult outpatients with nonpsychotic psychiatric illnesses. J. Atten. Disord. 11(2), 150-156 (2007).
6. Kessler RC, Adler L, Barkley R et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am. J. Psychiatry 163(4), 716-723 (2006).
7. MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch. Gen. Psychiatry 56(12), 1073-1086 (1999).
8. Robison LM, Skaer TL, Sclar DA, Galin RS. Is attention deficit hyperactivity disorder increasing among girls in the US? Trends in diagnosis and the prescribing of stimulants. CNS Drugs 16(2), 129-137 (2002).
9. Szatmari P, Offord DR, Boyle MH. Correlates, associated impairments and patterns of service utilization of children with attention deficit disorder: Findings from the Ontario Child Health Study. J. Child Psychol. Psychiatry 30(2), 205-217 (1989).
10. Bauermeister JJ, Shrout PE, Chávez L et al. ADHD and gender: are risks and sequela of ADHD the same for boys and girls? J. Child Psychol. Psychiatry 48(8), 831-839 (2007).
11. Staller J, Faraone SV. Attention-deficit hyperactivity disorder in girls: epidemiology and management. CNS Drugs 20(2), 107-123 (2006). • Excellent review of etiology, epidemiology and comorbidity that is specific to attentiondeficit/hyperactivity disorder (ADHD) in females. It summarizes key studies in all areas of functioning and discusses gender specific treatment-related issues.
12. Gershon J. A meta-analytic review of gender differences in ADHD. J. Atten. Disord. 5(3), 143-154 (2002).
13. Hinshaw SP. Preadolescent girls with Attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive and social functioning, and parenting practices. J. Consult. Clin. Psychol. 70(5), 1086-1098 (2002).
14. Carlson CL, Tamm L, Gaub M. Gender differences in children with ADHD, ODD, and co-occurring ADHD/ODD identified in a school population. J. Am. Acad. Child Adolesc. Psychiatry 36(12), 1706-1714 (1997).
15. Rucklidge JJ, Tannock R. Psychiatric, psychosocial, and cognitive functioning of female adolescents with ADHD. J. Am. Acad. Child Adolesc. Psychiatry 40(5), 530-540 (2001).
16. Rucklidge JJ, Brown D, Crawford S, Kaplan BJ. Attributional styles and psychosocial functioning of adults with ADHD. J. Atten. Disord. 10(3), 288-298 (2007). • Canadian study based on adults identified with ADHD in adulthood, confirmed that ADHD manifests itself similarly in males and females in terms of negative attributional styles, overall levels of dissatisfaction, and poor psychosocial functioning compared with non-ADHD controls. It is relevant in that it confirms the importance of considering psychosocial functioning of adults with ADHD when they are assessed and treatment plans are being developed.
17. Gross-Tsur V, Goldzweig G, Landau YE et al. The impact of sex and subtypes on cognitive and psychosocial aspects of ADHD. Dev. Med. Child Neurol. 48(11), 901-905 (2006). • Another study of great importance in the literature on gender differences in ADHD. This study supports the notion that ADHD in females is the same disorder as it is in males but that ADHD subtyping is a more salient determinant of ADHD core symptoms. Regardless of gender, this study, like many more before it, supports the significant risk of psychopathology in individuals affected with ADHD.
18. Levy F, Hay DA, Bennett KS, McStephen M. Gender differences in ADHD subtype comorbidity. J. Am. Acad. Child Adolesc. Psychiatry 44(4), 368-376 (2005). •• Gender studies are complicated by the inherent differences associated with the individual subtypes of ADHD. This study, using a large sample of twins in Australia, identifies that comorbidity differs between genders for all subtypes, emphasizing the importance of interpreting data that have not considered specific subtypes with great caution.
19. Cukrowicz KC, Taylor J, Schatschneider C, Iacono WG. Personality differences in children and adolescents with attention-deficit/hyperactivity disorder, conduct disorder, and controls. J. Child Psychol. Psychiatry 47(2), 151-159 (2006).
20. Hoza B, Gerdes AC, Hinshaw SP et al. Self-perceptions of competence in children with ADHD and comparison children. J. Consult. Clin. Psychol. 72(3), 382-391 (2004).
21. Hoza B, Pelham WE, Milich R, Pillow D, McBride K. The self-perceptions and attributions of attention deficit hyperactivity disordered and nonreferred boys. J. Abnorm. Child Psychol. 21(3), 271-286 (1993).
22. Abikoff HB, Jensen PS, Arnold LLE et al. Observed classroom behavior of children with ADHD: relationship to gender and comorbidity. J. Abnorm. Child Psychol. 30(4), 349-359 (2002).
23. Young S, Chadwick O, Heptinstall E, Taylor E, Sonuga-Barke EJS. The adolescent outcome of hyperactive girls: self-reported interpersonal relationships and coping mechanism. Eur. Child Adolesc. Psychiatry 14(5), 245-253 (2005).
24. Young S, Heptinstall E, Sonuga-Barke EJS, Chadwick O, Taylor E. The adolescent outcome of hyperactive girls: self-report of psychosocial status. J. Child Psychol. Psychiatry 46(3), 255-262 (2005).
25. Rucklidge JJ. Gender differences in neuropsychological functioning of New Zealand adolescents with and without attention deficit hyperactivity disorder. Int. J. Disab. Develop. Educ. 53(1), 47-66 (2006).
26. Yang P, Jong Y-J, Chung L-C, Chen C-S. Gender differences in a clinic-referred sample of Taiwanese attention-deficit/hyperactivity disorder children. Psychiatry Clin. Neurosci. 58(6), 619-623 (2004).
27. Newcorn J, Halperin JM, Jensen P et al. Symptom profiles in children with ADHD: efects of comorbidity and gender. J. Am. Acad. Child Adolesc. Psychiatry 40(2), 137-146 (2001).
28. Hartung CM, Willcutt EG, Lahey BB et al. Sex differences in young children who meet criteria for attention deficit hyperactivity disorder. J. Clin. Child Adolesc. Psychol. 31(4), 453-464 (2002).
29. Biederman J, Faraone S, Monuteaux M, Bober M, Cadogen E. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol. Psychiatry 55, 692-700 (2004).
30. Rucklidge JJ, Tannock R. Neuropsychological profiles of adolescents with ADHD: effects of reading difficulties and gender. J. Child Psychol. Psychiatry 43(8), 988-1003 (2002).
31. Seidman LJ, Biederman J, Monuteaux MC et al. Impact of gender and age on executive functioning: do girls and boys with and without attention deficit hyperactivity disorder differ neuropsychologically in preteen and teenage years? Dev. Neuropsychol. 27(1), 79-105 (2005).
32. Castellanos FX, Marvasti FF, Ducharme JL et al. Executive function oculomotor tasks in girls with ADHD. J. Am. Acad. Child Adolesc. Psychiatry 39(5), 644-650 (2000).
33. Seidman LJ, Biederman J, Faraone SV, Weber W. A pilot study of neuropsychological function in girls with ADHD. J. Am. Acad. Child Adolesc. Psychiatry 36(3), 366-373 (1997).
34. Weiss MD, Worling DE, Wasdell MB. A chart review study of the inattentive and combined types of ADHD. J. Atten. Disord. 7(1), 1-9 (2003).
35. Biederman J, Kwon A, Aleardi M et al. Absence of gender effects on attention deficit hyperactivity disorder: findings in nonreferred subjects. Am. J. Psychiatry 162(6), 1083-1089 (2005).
36. Dalsgaard S, Mortensen PB, Frydenberg M, Thomsen PH. Conduct problems, gender and adult psychiatric outcome of children with attention-deficit hyperactivity disorder. Br. J. Psychiatry 181(5), 416-421 (2002).
37. Novik TS, Hervas A, Ralston SJ et al. Influence of gender on Attention-Deficit/Hyperactivity Disorder in Europe - ADORE. Eur. Child Adolesc. Psychiatry 15(Suppl. 1), 5-24 (2006). • Examined ADHD in European girls and determined that although girls and boys with ADHD had similar levels of coexisting psychiatric problems, fewer girls were being referred for ADHD treatment despite having similar patterns of impairment. It also identified that these girls were more likely to be the victims of bullying.
38. Biederman J, Monuteaux MC, Mick E et al. Psychopathology in females with attention-deficit/hyperactivity disorder: a controlled, five-year prospective study. Biol. Psychiatry 60(10), 1098-1105 (2006).
39. Disney ER, Elkins IJ, McGue M, Iacono WG. Effects of ADHD, conduct disorder, and gender of substance use and abuse in adolescence. Am. J. Psychiatry 156(10), 1515-1521 (1999).
40. Biederman J, Ball SW, Monuteaux MC et al. Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. J. Dev. Behav. Pediatr. 28(4), 302-307 (2007).
41. Lahey BB, Hartung CM, Loney J et al. Are there sex differences in the predictive validity of DSM-IV ADHD among younger children? J. Clin. Child Adolesc. Psychol. 36(2), 113-126 (2007).
42. Graetz BW, Sawyer MG, Baghurst P, Ettridge K. Are ADHD gender patterns moderated by sample source? J. Atten. Disord. 10(1), 36-43 (2006).
43. Weinstein D, Staffelbach D, Biaggio M. Attention-deficit hyperactivity disorder and posttraumatic stress disorder: differential diagnosis in childhood sexual abuse. Clin. Psychol. Rev. 20, 359-378 (2000).
44. Glod CA, Teicher MH. Relationship between early abuse, posttraumatic stress disorder, and activity levels in prepubertal children. J. Am. Acad. Child Adolesc. Psychiatry 35, 1384-1393 (1996).
45. Merry SN, Andrews LK. Psychiatric status of sexually abused children 12 months after disclosure of abuse. J. Am. Acad. Child Adolesc. Psychiatry 33, 939-946 (1994).
46. McLeer SV, Callaghan M, Henry D, Wallen J. Psychiatric disorders in sexually abused children. J. Am. Acad. Child Adolesc. Psychiatry 35, 313-317 (1994).
47. Rucklidge JJ, Brown DL, Crawford S, Kaplan BJ. Retrospective reports of childhood trauma in adults with ADHD. J. Atten. Disord. 9, 631-641 (2006).
48. Gaub M, Carlson CL. Gender differences in ADHD: a meta-analysis and critical review. J. Am. Acad. Child Adolesc. Psychiatry 36(8), 1036-1045 (1997).
49. Monuteaux MC, Fitzmaurice G, Blacker D, Buka SL, Biederman J. Specificity in the familial aggregation of overt and covert conduct disorder symptoms in a referred attention-deficit hyperactivity disorder sample. Psychol. Med. 34(6), 1113-1127 (2004).
50. Barkley RA. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (3rd Edition). The Guilford Press, NY, USA (2006).
51. Sagvolden T, Aase H, Johansen EB, Russell VA. A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. Behav. Brain Sci. 28(3), 397-468 (2005).
52. Conners CK, Epstein JN, March JS et al. Multimodal treatment of ADHD in the MTA: an alternative outcome analysis. J. Am. Acad. Child Adolesc. Psychiatry 40(2), 159-167 (2001).
53. Group MTAC. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Pediatrics 113(4), 762-769 (2004).
54. Greene RW, Ablon JS. What does the MTA study tell us about effective psychosocial treatment for ADHD? J. Clin. Child Psychol. 30(1), 114-121 (2001).
55. Barkley RA. A theory of ADHD. In: Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (3rd Edition). Barkley, RA (Ed.). The Guilford Press, NY, USA 297-394 (2006).
56. Safren SA, Otto MW, Sprich S et al. Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behav. Res. Ther. 43(7), 831-842 (2005).
57. Rostain AL, Ramsay JR. A Combined treatment approach for adults with ADHD - results of an open study of 43 patients. J. Atten. Disord. 10(2), 150-159 (2006).
58. Ramsay JR, Rostain AL. Cognitive therapy for adult ADHD. In: Innovations in Clinical Practice: Focus on Adults. A Volume in the Innovations in Clinical Practice Series. VandeCreek, L (Ed.). Professional Resource Press/Professional Resource Exchange, FL, USA 53-63 (2005). •• Psychosocial treatments for adults with ADHD have only recently been studied empirically. These authors describe their attempts to develop a cognitive-behavioral package that is suitable for the ADHD client. It has some empirical support and the article describes practical ways to improve clinical practice with these highly impaired individuals.
59. Hesslinger B, van Elst LT, Nyberg E et al. Psychotherapy of attention deficit hyperactivity disorder in adults: a pilot study using a structured skills training program. Eur. Arch. Psychiatry Clin. Neurosci. 252(4), 177-184 (2002).
60. McInnes A, Bedard A-C, Hogg-Johnson S, Tannock R. Preliminary evidence of beneficial effects of methylphenidate on listening comparison in children with attention-deficit/hyperactivity disorder. J. Child Adolesc. Psychopharmacol. 17(1), 35-49 (2007).
61. Bedard A-C, Martinussen R, Ickowicz A, Tannock R. Methylphenidate improves visual-spatial memory in children with attention-deficit/hyperactivity disorder. J. Am. Acad. Child Adolesc. Psychiatry 43(3), 260-268 (2004).
62. Barkley R, Cox D. A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. J. Safety Res. 38, 113-128 (2007).
63. Fischer M, Barkley RA, Smallish L, Fletcher K. Hyperactive children as young adults: driving abilities, safe driving behavior, and adverse driving outcomes. Accid. Anal. Prev. 39(1), 94-105 (2007).
64. Nada-Raja S, Lagley JD, McGee R et al. Inattentive and hyperactivity behaviors and driving offences in adolescence. J. Am. Acad. Child Adolesc. Psychiatry 36, 515-522 (1997).
65. Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult outcome of hyperactive children: adaptive functioning in major life activities. J. Am. Acad. Child Adolesc. Psychiatry 45(2), 192-202 (2006).
66. Murphy K. Psychosocial treatments for ADHD in teens and adults: a practice-friendly review. J. Clin. Psychol. 61(5), 607-619 (2005). •• Given that there are so many co-occurring problems associated with ADHD, it is essential that clinicians are aware of the options for treating adults with ADHD that can be employed alongside medication. A practical article with an emphasis on instilling hope and developing self-management skills, it also details other treatment options including group work, career counselling, using technologies and coaches.
67. Kandel RA. Predicting adherence to treatment recommendations for children with ADHD. Dissertation Abstracts International: Section B: The Sciences and Engineering 66(12-B), 6926 (2006).
68. Spencer T, Biederman J, Wilens T et al. A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Biol. Psychiatry 57(5), 456-463 (2005).
69. Sharp WS, Walter JM, Marsh WL et al. ADHD in girls: clinical comparability of a research sample. J. Am. Acad. Child Adolesc. Psychiatry 38(1), 40-47 (1999).
70. Quinn PO. Treating adolescent girls and women with ADHD: gender-specific issues. J. Clin. Psychol. 61(5), 579-587 (2005). •• Given that there are so few resources and articles written to specifically address gender-specific issues, this article is a valuable resource for clinicians struggling to identify areas of concern that may be unique to girls and women with ADHD. Dr Quinn uses a case study to illustrate the specific difficulties facing females with ADHD.
71. Justice AJ, deWit H. Acute effects of estradiol pretreatment on the response to D-amphetamine in women. Neuroendocrinology 71, 51-59 (2000).
72. Owens EB, Hinshaw SP, Kraemer HC et al. Which treatment for whom for ADHD? Moderators of treatment response in the MTA. J. Consult. Clin. Psychol. 71(3), 540-552 (2003).
73. Jensen PS, Arnold LE, Swanson JM et al. 3-year follow-up of the NIMH MTA study. J. Am. Acad. Child Adolesc. Psychiatry 46(8), 989-1002 (2007).
74. Nangle DW, Erdley CA, Carpenter EM, Newman JE. Social skills training as a treatment for aggressive children and adolescents: a developmental-clinical integration. Aggr. Viol. Behav. 7(2), 169-199 (2002).
75. de Boo GM, Prins PJM. Social incompetence in children with ADHD: possible moderators and mediators in social-skills training. Clin. Psychol. Rev. 27(1), 78-97 (2007).
76. Berger DF, Sagvolden T. Sex differences in operant discrimination behaviour in an animal model of attention-deficit hyperactivity disorder. Behav. Brain Res. 94(1), 73-82 (1998).
77. Quinn P, Nadeau K. Future directions: women with AD/HD in the 21st century. In: Gender Issues and AD/HD: Research, Diagnosis and Treatment. Quinn PO, Nadeau KG (Eds). Advantage Books, MD, USA 448-459 (2002).
78. Sohlberg MM, Mateer CA. Improving attention and managing attentional problems: adapting rehabilitation techniques to adults with ADD. Ann. NY Acad. Sci. 931, 359-375 (2001).
79. Klingberg T, Fernell E, Olesen PJ et al. Computerized training of working memory in children with ADHD - a randomized, controlled trial. J. Am. Acad. Child Adolesc. Psychiatry 44(2), 177-186 (2005).
80. Solden S. Beyond early identification: developing healthy self-concepts in girls with ADD. Emot. Behav. Diff. 1(3), 36-40 (1996).
81. Philipsen A. Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults. Eur. Arch. Psychiatry Clin. Neurosci. 256(Suppl. 1), 42-46 (2006).
82. Diamantopoulou S, Henricsson L, Rydell A-M. ADHD symptoms and peer relations of children in a community sample: examining associated problems, self-perceptions, and gender differences. Int. J. Behav. Develop. 29(5), 388-398 (2005).
83. Ohan JL, Johnston C. Are the performance overestimates given by boys with ADHD self-protective? J. Clin. Child Adolesc. Psychol. 31(2), 230-241 (2002).
84. Kelley SDM, English W, Schwallie-Giddis P, Jones LM. Exemplary counseling strategies for developmental transitions of young women with attention deficit/hyperactivity disorder. J. Couns. Develop. 85, 173-181 (2007).
85. Waite R. Women and attention deficit disorders: a great burden overlooked. J. Am. Acad. Nurse Pract. 19(3), 116-125 (2007).
86. Taylor EW, Keltner NL. Messy purse girls: Adult females and ADHD. Perspect. Psychiatr. Care 38(2), 69-72 (2002).
87. Ramsay JR, Rostain AL. Girl, repeatedly interrupted: the case of a young adult woman with ADHD. Clinical Case Studies 4(4), 329-346 (2005).
88. Robison LM, Sclar DA, Skaer TL, Galin RS. Treatment modalities among US children diagnosed with attention-deficit hyperactivity disorder: 1995-99. Int. Clin. Psychopharmacol. 19(1), 17-22 (2004).
89. Bussing R, Koro-Ljungberg ME, Gary F, Mason DM, Garvan CW. Exploring help-seeking for ADHD symptoms: a mixed-methods approach. Harv. Rev. Psychiatry 13(2), 85-101 (2005).
90. Reid R, Riccio CA, Kessler RH et al. Gender and ethnic differences in ADHD as assessed by behavior ratings. J. Emot. Behav. Disord. 8(1), 38-48 (2000).
91. Ohan JL, Johnston C. Gender appropriateness of symptom criteria for attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and conduct disorder. Child Psychiatry Hum. Dev. 35(4), 359-381 (2005).
92. Nadeau KG, Quinn PO. Women's AD/HD Self Assessment symptom inventory. In: Understanding Women With AD/HD. Nadeau KG, Quinn PO (Eds). Advantage Books, MD, USA, 24-43 (2002).
93. Pelham J, William E, Fabiano GA, Massetti GM. Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. J. Clin. Child Adolesc. Psychol. 34(3), 449-476 (2005).
94. Healey DM, Miller CJ, Castelli KL, Marks DJ, Halperin JM. The impact of impairment criteria on rates of ADHD diagnoses in preschoolers. J. Abnorm. Child Psychol. (2008) (Epub ahead of print).
95. Hartung CM, Van Pelt JC, Armendariz ML, Knight LA. Biases in ratings of disruptive behavior in children: effects of sex and negative halos. J. Atten. Disord. 9(4), 620-630 (2006).
96. Stevens J, Quittner AL, Abikoff H. Factors influencing elementary school teachers' ratings of ADHD and ODD behaviors. J. Clin. Child Psychol. 27(4), 406-414 (1998).
97. Jackson DA, King AR. Gender differences in the effects of oppositional behavior on teacher ratings of ADHD symptoms. J. Abnorm. Child Psychol. 32(2), 215-224 (2004).
98. Barry RJ, Clarke AR, McCarthy R, Selikowitz M. Age and gender effects in EEG coherence: III. Girls with attention-deficit/hyperactivity disorder. Clin. Neurophysiol. 117(2), 243-251 (2006).
99. Rosler M, Retz W, Retz-Junginger P et al. Prevalence of attention deficit-/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates. Eur. Arch. Psychiatry Clin. Neurosci. 254(6), 365-371 (2004).